Will the doctor be in?

Mississippi will need more hands to provide primary medical care, especially if health care reform becomes a reality, a recent study has found.
An analysis by Mississippi State University Social Science Research Center shows that Mississippi would need 52 more primary care physicians based on the first year of Massachusetts Health Care Program, where insurance is mandated.
And much of the current health care debate includes discussions about whether people should be required to have insurance or face a penalty.
“If we look at a possible mandate for health insurance, the shortage is even worse” than it is now in Mississippi, said MSU associate sociology professor Lynne Cossman, who wrote the health work force paper with researchers C. Caleb Butts and Nicholas DiColandrea.
That’s despite a very large “surplus” of primary care doctors in Hinds County, and more modest surpluses in population centers around Hattiesburg, Biloxi, Tupelo, Oxford and Meridian.
“We’re not encouraging people to leave” the more well-supplied areas, Cossman said. “I don’t think any primary care providers will tell you they don’t have plenty to do.”
The worst shortages show up in some of the fastest growing areas of the state, like DeSoto and Rankin counties. However, people in those areas are likely accessing primary care services across state lines in Memphis or in Hinds County, which has at least 200 more primary care physicians.
However, there also is a chronic under supply of primary care in rural areas.
In Tippah County, for example, there is a need for 11 physicians to achieve a level of sustainability with a potential new health insurance mandate. That’s more than double the current number of physicians.
“The market will not correct itself,” said Dr. Mike O’Dell, director of medical education for Tupelo-based North Mississippi Health Services. “Right now, there are not enough primary care doctors; they can practice anywhere they choose to. … It’s more acute in the fast-growing areas that have outstriped their primary care infrastructure.”
Primary care providers – physicians in family medicine, internal medicine and pediatrics – are considered the backbone of the health care system. Well-respected research has found that in both developed and undeveloped countries, where there is a strong primary care base, health care costs less and quality of care is improved.
Primary care physicians are affected by the same demographic shifts that are creating shortages in other health fields like nursing. Baby boomers are beginning to retire and need more health care at the same time.
But the shortage of primary care physicians is more than that.
“Health care is growing at a faster rate than the rest of the economy,” Cossman said. “We need more people.”
When Massachusetts instituted a health insurance mandate, they were able to get 48 percent of uninsured families insured in the first year of the program.
Because people who have insurance visit their doctor, on average, at least one more time a year than people without health insurance, there is expected to be a significant increase in demand for primary care doctors with mandated health insurance, Cossman said.
About 20 percent of Mississippians currently don’t have health insurance. The projections for primary care needs were based on the Massachusetts experience, where about 48 percent of the uninsured became insured during the first year of the program.
Using 2006 data from medical licenses of primary care physicians, the U.S. Census and estimates of the number of annual physician visits, the MSU researchers developed the models on the needed number of primary care physicians.
When the researchers considered microregions of contiguous counties, Lee County and almost all of Northeast Mississippi has a significant under supply of primary care physicians.

Solutions
Because the whole country is facing a shortage of primary care physicians, there’s no easy fix filling the ranks of primary care.
“It takes about 10 years,” Cossman said, for a primary care physician to complete college, medical school and residency training.
Part of the equation is getting more medical students interested in what primary care has to offer and better preparing students from rural areas so they can pursue medical careers
“We need to raise the profile and prestige of primary care,” said Janie Guice, executive director of the Mississippi Rural Medical Scholarship Program.
The scholarship program, which was approved by the Legislature, provides $30,000 annual scholarships to medical students interested in practicing in five primary care fields, which includes obstetrics and gynecology, said Guice, who will speak to the Tupelo Rotary Club on Oct. 19. It also provides undergraduate students interested in primary care in rural areas with assistance preparing for medical school entrance exams and connects them with doctors practicing in rural areas.
MSU has a rural medical scholars program that starts with high school juniors who come for pre-med-focused classes during the summer.
“We have ramped up the pipeline that starts with college,” said O’Dell, whose new role is to expand the medical education opportunities in the NMMC-system.
Ultimately, the best solution for rural areas is to grow their own primary care physicians.
Because of reimbursement rates with Medicare and private insurance, there’s not a business incentive for primary care doctors to locate in underserved areas because they will make about the same amount of money anywhere. Lifestyle, cost of living and family considerations are the biggest factors, O’Dell said.
Providing loan incentives for physicians who practice in underserved areas has been only marginally successful, O’Dell said. The doctors often only stay for the terms of the loan repayment.
“That’s part of the beauty of having a residency here,” in Tupelo, O’Dell said. “If residents train here, they’re likely to stay in the surrounding area.”
The NMMC Family Residency Center has seen recent graduates head to places like Eupora and Pontotoc to be close to family in their professional careers. Two current residents have plans to go home to Tippah County to practice.
“That family tie really helps,” O’Dell said.